<include file="../header" />
<body class="J_scroll_fixed">
<script type="text/javascript">
    $(function() {



    })

</script>
<script type="text/javascript"  src="__TMP__/assets/js/ueditor/ueditor.config.js"></script>
<script type="text/javascript"  src="__TMP__/assets/js/ueditor/ueditor.all.min.js"></script>
<div class="wrap jj">
    <div class="common-form">
        <form method="post" class="form-horizontal J_ajaxForm" action="{:U('order/receive')}">
            <fieldset>
                <input type="hidden" value="{$order.order_id}" name="id" />
                <div class="control-group">
                    <label class="control-label">收款金额：</label>
                    <div class="controls">
                        <input type="text" class="input" name="receiptAmount" value="">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">单号后四位：</label>
                    <div class="controls">
                        <input type="text" maxlength="4" class="input" name="receiptNumber" value="">
                    </div>
                </div>
            </fieldset>
            <div class="form-actions">
                <button type="submit" class="btn btn-primary btn_submit">确认收款</button>
                <a class="btn" href="__URL__">返回</a>
            </div>
        </form>
    </div>
</div>
<script src="__ROOT__/statics/js/common.js"></script>
</body>
</html>